Near Infrared Brain Imaging for Guiding Treatment in Children with Cerebral Palsy Abstract We propose a feasibility study for the translation of functional near infrared (fNIR) brain imaging as a tool to guide the treatment of children diagnosed with cerebral palsy (CP). This motor deficit profoundly affects a child's ability to develop age-typical motor skills and to engage fully in play, exploration and self-help activities. Currently, treatments are being assigned blindly and as a result many pediatric patients undergo futile and taxing treatments that last for prolonged periods of time. Neuroimaging techniques are useful to study neuroplastic rearrangements in response to a given treatment and aide physicians to factor that information into treatment decisions. Functional magnetic resonance imaging has being employed in few cases, but this technique requires the patients' complete body confinement and steadiness for a long period of time, which is hard to attain for children with CP. fNIR imaging has been demonstrated as a sensitive method to map functional activities in the healthy human motor cortex and is relatively immune from patient motion artifacts, is cost effective, and can be widely deployable in a clinical setting. The focus of this proposal is to explore the rich information offered by fNIR imaging as a means to understand cortical plasticity in response to a Constraint Induced Motion Therapy (CIMT), which is one of the most prevalent and promising treatments available to date. Our hypothesis is that specific spatiotemporal fNIR cortical activation patterns exist that are strong predictors of CIMT treatment outcomes. Novel fNIR head probe technology is presented that increases setup speed and comfort for the children during measurements while cortical activation patterns and functional connectivity are explored across their entire head top. In addition, fNIR imaging of cortical activation due to arm motions will be integrated with camera-based motion analysis methods to provide objective measures of functional performance, in contrast to current qualitative clinical assessment methods. Multivariate analysis between fNIR metrics and functional performance measures will be performed pre- and post-treatment to test our hypothesis. Accordingly, our specific aims are: (1) To construct and characterize the performance characteristics of a user-friendly fNIR probe assembly spanning the entire head top, and identify a cohort of spatiotemporal cortical activation metrics that correlate with motion analysis performance metrics in adult volunteers performing different hand motions; (2) To quantify the spatiotemporal activation metrics obtained with the head probe from children with CP and age-matched pediatric controls, while they perform different hand motions, and test how these metrics correlate with motion analysis metrics for different motor impairment levels; (3) Identify changes in the cortical activation patterns found to correlate with motion analysis for children with CP performing a variety of hand motions, immediately after and 6 months post-treatment, and identify which pre-treatment fNIR metrics can serve as predictors of CIMT success for each motor impairment level. PUBLIC HEALTH RELEVANCE: Near Infrared Brain Imaging for Guiding Treatment in Children with Cerebral Palsy Project Narrative We will use near infrared light to map how neuronal networks on the surface of the brain of children reorganize their activity as a result of an early life stroke event that caused partial paralysis of the extremities. This condition is known as cerebral palsy, a common motor disorder in children. We propose to develop methods that physicians could use to assess the severity of cerebral palsy as well as help them decide if a given treatment option will have a positive outcome for each individual patient.